Windler Eberhard, Schöffauer Mark, Zyriax Birgit-Christiane
Center of Internal Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Diab Vasc Dis Res. 2007 Jun;4(2):136-42. doi: 10.3132/dvdr.2007.032.
In most developed and developing countries, the proportion of the population aged 60 years or more is growing faster than any other age group. Given that the vast majority of cardiovascular events occur in older individuals, new thinking is needed to reduce their risk. Epidemiological studies have shown an increasing prevalence of the metabolic syndrome with age, driven by nutrition inappropriate for a modern sedentary lifestyle. A low level of high-density lipoprotein (HDL)-cholesterol, a component of the atherogenic dyslipidaemia of the metabolic syndrome, has been shown to be an important determinant of coronary risk, which rises in prevalence with increasing age. Thus, raising HDLcholesterol, in addition to lowering the level of low-density lipoprotein (LDL)-cholesterol, seems a plausible approach to reduce cardiovascular risk in an ageing population. Clinical studies have shown that adding nicotinic acid, which raises HDL-cholesterol by 20-25%, to a statin enhances the reduction in progression of atherosclerosis. Results of the ongoing Atherothrombosis Intervention in Metabolic syndrome with low HDL/High triglyceride and Impact on Global Health Outcomes (AIM-HIGH) study are awaited with interest to see whether such theoretical benefit translates into clinical outcome.
在大多数发达国家和发展中国家，60岁及以上人口的比例增长速度超过其他任何年龄组。鉴于绝大多数心血管事件发生在老年人身上，需要新的思路来降低他们的风险。流行病学研究表明，由于现代久坐生活方式下营养不当，代谢综合征的患病率随年龄增长而上升。代谢综合征致动脉粥样硬化性血脂异常的一个组成部分——高密度脂蛋白（HDL）胆固醇水平低，已被证明是冠状动脉风险的一个重要决定因素，其患病率随年龄增长而上升。因此，除了降低低密度脂蛋白（LDL）胆固醇水平外，提高HDL胆固醇似乎是降低老年人群心血管风险的一种合理方法。临床研究表明，在他汀类药物中添加烟酸（可使HDL胆固醇升高20%-25%）可增强动脉粥样硬化进展的降低效果。人们期待着正在进行的低HDL/高甘油三酯代谢综合征动脉粥样硬化血栓形成干预及对全球健康结局的影响（AIM-HIGH）研究的结果，以了解这种理论上的益处是否能转化为临床结局。
